Contracting

Blue Choice PPO is a product with a specific network of participating providers. Members who obtain care within the Blue Choice PPO network will receive the highest level of benefits. Members also have the option of obtaining care from with in the PPO network or going out-of-network. In either case the member will incur a lower level of benefits.

Referrals
Written referrals are not required, but when a referral is necessary, providers in the Blue Choice PPO network must make every effort to refer the member to in-network Blue Choice PPO providers, hospitals, and other medical facilities for services.

In instances where a referral is made to an out-of-network provider and/or to an entity with whom the contracting provider has a business interest, the member must be notified of the same in writing at the time of the referral. Referrals to out-of-network providers could result in reduced benefits for the member.

Reimbursement
Reimbursement is based on fee-for-service in accordance with the Blue Choice PPO Schedule of Maximum Allowances (SMA).

Member Payments
Providers should bill BCBSIL prior to collecting any fees other than copayments from the member. After the claim is adjudicated, providers may bill the member for any deductibles, coinsurance, or non-covered services.

Providers may not balance bill the member for any fees over the allowable charge.

Credentialing Requirements
All providers applying for participation in the Blue Choice PPO network must complete a credentialing process prior to acceptance. For more information on how to register and complete the online credentialing application, visit the Credentialing Process section.

Eligible Providers:

Primary Care Physicians

• Family/General Practice
• Internal Medicine
• Pediatric Medicine
• Obstetrics/Gynecological Medicine
• Certified Nurse Midwife

Primary Specialist Physician List

Blue Choice PPO Service Area

The Blue Choice PPO network service area includes all counties in Illinois with the exception of Lawrence, and Wabash counties.

Provider Onboarding Form

BCBSIL offers BCCHP which includes a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support (LTSS) and other health care providers through which Illinois Medicaid members may obtain covered services.

Referrals
Referrals to in-network specialists or for emergency and urgent care are not required. Referrals are always required for non-emergent care received from an out-of-network provider. There are preauthorization requirements for selected non-emergency service provided to BCCHP members. Please consult the authorizations list posted in the Related Resources on the Medicaid page.

Member Payments
BCCHP members are not charged any co-pays. Members must be provided with an Advanced Beneficiary Notice for any services rendered that are non-covered under the Medicaid program.

Credentialing Requirements
Effective Jan. 1, 2018, the State of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers that participate in the BCCHP Medicaid plan. To be eligible to participate, the physician and certain other providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. For more information, visit the IMPACT website. Providers with general questions about IMPACT or provider enrollment may email IMPACT Help or call 877-782-5565 (select option #1).

Request to Participate

Interested providers should complete the Provider Onboarding Form. Completion of the Universal IAMHP Roster Template and Attestation form will also be needed for contracting.

Provider Onboarding Form

BCBSIL offers MMAI which serves individuals eligible for both Medicare and Medicaid to provide integrated, comprehensive care. The network consists of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, long-term services and support and other health care providers through which members may obtain Covered Services.

BCBSIL provides services to MMAI members in all counties of Illinois excluding Champaign and Massac counties.

Referrals
Referrals to in-network specialists or for emergency and urgent care are not required. Referrals are always required for non-emergent care received from an out-of-network provider. There are preauthorization requirements for selected non-emergency service provided to MMAI members. Please consult the authorizations list posted in the Related Resources on the Medicaid page.

Member Payments
MMAI members are not charged any co-pays. Members must be provided with an Advanced Beneficiary Notice for any services rendered that are non-covered under the Medicaid program.

Credentialing Requirements
Effective Jan. 1, 2018, the State of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers that participate in MMAI. To be eligible to participate, the physician and certain other providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. For more information, visit the IMPACT website . Providers with general questions about IMPACT or provider enrollment may email IMPACT.Help@Illinois.gov or call 877-782-5565 (select option #1).

Request to Participate
Interested providers should complete the Provider Onboarding Form.  Completion of the Universal IAMHP Roster Template and Attestation form will also be needed for contracting.

Provider Onboarding Form 

Request to Participate

Interested providers should complete the Provider Onboarding Form. 

Based on your provider type, please reach out to one of the below contacts to express interest in joining the BlueHPN. Each request will be evaluated on a case-by-case basis for potential admittance to the network.

Facilities (hospitals, ambulatory surgery centers or behavioral health facilities only) to apply to join our networks send an email to Facility Contract Notices.

Professional Providers to apply to join our networks send an email to Network Contracting.

Ancillary Professional Providers to apply to join our networks send an email to Ancillary Networks.

BCBSIL does not contract directly with providers for our HMO products.

Providers who would like to participate in our HMO network must contact a BCBSIL contracting HMO Medical Group or IPA in their area.

View HMO Medical Group/IPA listing 

Our PPO professional network is made up of professional providers that agree to fees set by BCBSIL as the maximum cost for their services.

You must provide services in Illinois or Lake County, Indiana in order to apply.

Referrals
Written referrals are not required, but when a referral is necessary, the PPO provider must make every effort to refer the member to in-network PPO providers, hospitals, and other medical facilities for services.

In instances where a referral is made to an out-of-network provider and/or to an entity with whom the Contracting Provider has a business interest, the member must be notified of the same in writing at the time of the referral. Referrals to out-of-network providers could result in reduced benefits for the member.

Reimbursement
Payment for services is according to the PPO Schedule of Maximum Allowances (SMA).

Member Payments
Providers should bill BCBSIL prior to collecting any fees other than copayments from the member. After the claim is adjudicated, providers may bill the member for any deductibles, coinsurance, or non-covered services.

Credentialing Requirements
All providers applying for participation in the PPO network must complete a credentialing process prior to acceptance. For more information on how to register and complete the online credentialing application, visit the Credentialing Process section.

Providers may not balance bill the member for any fees over the allowable charge.

The PPO Professional Networks includes the following eligible provider types:

• Advanced Nurse Practitioner (APN)
• Applied Behavior Analyst (ABA)
• Audiologist (AUD)
• Board Certified Behavioral Analyst (BCBA)
• Certified Nurse Midwife (CNM)
• Certified Nurse Practitioner (CNP)
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Surgical Assistant (CSA)
• Chiropractor (DC)
• Clinical Psychologist
• Developmental Therapist
• Doctors of Naprapaths
• Independent Lab
• Licensed Acupuncturists
• Licensed Clinical Nurse Specialist (LCNS)
• Licensed Clinical Professional Counselors (LCPC)
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist LMFT)
• Optometrist (OD)
• Oral Maxillofacial Surgeon
• Osteopath (DO)
• Physician (MD)
• Physician Assistant (PA)
• Podiatrist (DPM)
• Registered Dietitians
• Registered Nurse First Assistant (RNFA)
• Registered Surgical Assistant (RSA)
• Sleep Medicine Centers
• Surgical Assistant Certified (SAC)
• Therapist (Physical-PT, Speech-ST, Occupational-OT) 

Note: If you are an Ancillary Provider (DME, Orthotic Supplier, Prosthetic Supplier or Home Infusion) and wish to contract with BCBSIL, email your request to Ancillary Contracting.

Provider Onboarding Form